Padilla, Warren, Colleagues Press Trump Administration on CMS Guidance that Could Threaten Nursing Home Residents’ Right to Vote

WASHINGTON, D.C. - U.S. Senators Alex Padilla (D-Calif.), Ranking Member of the Senate Rules and Administration Committee, and Elizabeth Warren (D-Mass.) led 11 of their Senate colleagues in urging the Centers for Medicare & Medicaid Services (CMS) Administrator Mehmet Oz to repeal new guidance that threatens nursing home residents' right to vote. In California, more than 400,000 nursing home residents would be impacted by the new guidance.

"We write with concern that the recent guidance issued to nursing homes by the Centers for Medicare and Medicaid Services may intimidate nursing home staff from helping residents exercise their constitutional right to vote and ultimately prevent nursing home residents from voting," wrote the Senators.

Last month, CMS issued new guidance regarding the responsibilities of nursing home staff in the voting process. Previous CMS guidance, including under the first Trump Administration, provided nursing home staff with a list of specific ways nursing homes can make it easier for residents to vote, like assisting with absentee and mail-in voting or transporting residents to polling locations and ballot drop-off boxes. However, the new guidance eliminated these recommendations, replacing them with language warning nursing home staff not to "violate federal or state voting laws" and telling staff that "they cannot engage in inappropriate coercion or other violations of residents' rights."

"[This memo] appears to be an attempt to intimidate nursing home staff from assisting residents in the voting process," continued the Senators.

To reiterate this threat of investigation or prosecution, CMS's July 2026 memo mentions two investigations of supposed election fraud occurring at nursing homes. However, no fraudulent votes were cast in either of these cases, and there is no evidence of any systemic or significant voter fraud or coercion in nursing homes.

The Senators also raised concerns that the Trump Administration's decision to highlight examples of prior voter fraud investigations and threaten criminal penalties may be an attempt to intimidate legal immigrants who work in nursing homes, who have already been targeted by the Administration's policies.

"Ultimately, we are concerned that the changes to CMS's guidance will result in the disenfranchisement of nursing home residents," wrote the Senators. "The right to vote is guaranteed by the Constitution to all adult Americans, including nursing home residents…In order to protect nursing home residents' voting rights, we request that you immediately rescind the July 2026 memo and reinstate the 2020 and 2024 guidance."

In addition to Padilla and Warren, the letter was signed by Senators Angela Alsobrooks (D-Md.), Richard Blumenthal (D-Conn.), Cory Booker (D-N.J.), Kirsten Gillibrand (D-N.Y.), Mazie Hirono (D-Hawaii), Andy Kim (D-N.J.), Angus King (I-Maine), Jeff Merkley (D-Ore.), Mark Warner (D-Va.), Raphael Warnock (D-Ga.), and Ron Wyden (D-Ore.).

As California's former Secretary of State, Padilla knows first-hand the importance of taking proactive steps to protect the fundamental right to vote. Last week, Padilla led his Senate colleagues in once again defeating MAGA Republicans' efforts to advance a provision of the anti-voter SAVE Act that would require eligible voters to provide strict photo identification when voting, including in their mail and absentee ballots. Last month, Padilla introduced the SHIELD Our Elections Act, legislation that would provide state Attorneys General and voters with the ability to enforce federal election protections and protect voters' ballots from seizure. In June, together with U.S. Senator Jon Ossoff (D-Ga.), Padilla reintroduced the Right to Vote Act, legislation to create the first-ever affirmative federal voting rights guarantee for all eligible citizens.

Full letter is available here or below:

Dear Administrator Oz:

We write with concern that the recent guidance issued to nursing homes by the Centers for Medicare and Medicaid Services (CMS) may intimidate nursing home staff from helping residents exercise their constitutional right to vote and ultimately prevent nursing home residents from voting. The nation's 1.2 million nursing home residents face unique problems in obtaining access to the voting booth, and must not be denied their rights because they are disabled, elderly, lack transit, or face difficulties in obtaining a ballot or voting in person.

In October 2020, during the first Trump Administration, CMS issued a memo titled "Compliance with Residents' Rights Requirement related to Nursing Home Residents' Right to Vote." The memo reminded nursing homes that CMS regulations require them to "support a resident in the exercise of their right … to vote, such as assisting with absentee or mail-in voting, or transporting residents to polling locations or ballot drop boxes in a safe manner." The memo listed programs that nursing homes may operate in order to enable their residents to vote, and cited the specific CMS regulations articulating nursing homes' responsibility to protect and facilitate residents' right to vote by mail. The memo also stated that nursing homes must ensure residents voting by mail "have the right to receive and send their ballots via the U.S. Postal Service, or other authorized mechanism allowed by the State or locality."

The Biden Administration renewed this guidance in September 2024. In the updated memo, CMS "reinforc[ed] the regulatory expectations" that nursing homes "affirm and support the right of residents to vote," reiterated nursing homes' responsibility to ensure residents can vote by mail, and cited the specific CMS regulations related to vote by mail.

However, on July 20, 2026, CMS issued a memo that appears to be an attempt to intimidate nursing home staff from assisting residents in the voting process. The newly released memo, titled "Protecting the Voting Rights and Autonomy of Vulnerable Residents in Long-Term Care (LTC) Facilities," replaces language from CMS's 2020 and 2024 guidance aimed at ensuring that facilities helped residents to vote with language threatening nursing home staff with prosecution for voter fraud. Specifically, the new memo removes suggestions of the specific ways nursing homes can facilitate voting and the references to CMS regulations related to voting by mail and instead baselessly emphasizes the risk that staff may exert "undue influence" on residents. The memo warns nursing home staff not to "violate federal or state voting laws" and reminds staff that "they cannot engage in inappropriate coercion or other violations of residents' rights." To reiterate this threat of investigation or prosecution, the July 2026 memo discusses two investigations of supposed election fraud occurring at nursing homes. However, no fraudulent votes were cast in either of these cases, and there is no evidence of any systemic or significant voter fraud or coercion in nursing homes.

CMS's release of this memo is just the latest in a series of actions the Trump Administration has taken to restrict vote by mail and undermine the right to vote based on unfounded allegations of voter fraud tied to the President's denial of prior valid election results. We are concerned that by highlighting examples of prior voter fraud investigations and threatening criminal penalties on nursing home staff-many of whom are legal immigrants who have already been targeted by Trump's immigration policies-CMS's July 2026 guidance may intimidate nursing home staff from helping residents with the voting process. And the removal of guidance on vote by mail procedures, combined with specific threats to investigate nursing home staff for assisting residents who are exercising their right to vote, may deter nursing homes from assisting residents with voting by mail. Ultimately, we are concerned that the changes to CMS's guidance will result in the disenfranchisement of nursing home residents.

The right to vote is guaranteed by the Constitution to all adult Americans, including nursing home residents. And CMS regulations require that each nursing home resident "be supported by the facility in the exercise of his or her rights." While CMS's 2020 and 2024 guidance assisted nursing homes in carrying out that responsibility, we are concerned that CMS's new guidance will hinder their ability to do so. In order to protect nursing home residents' voting rights, we request that you immediately rescind the July 2026 memo and reinstate the 2020 and 2024 guidance.

Sincerely,

###